Friday, 14 March 2014

Politics: Health Inequality and the NHS

Socioecomic position and health. Is it relevant to MS? #MSBlog #MSResearch

It is uncontroversial that socio-economic position (SEP) directly and indirectly effects quality of health and more and more quality of health provision. Class inequalities characterize over four fifths of officially recorded causes of death. There are pivotal and fundamental symptoms of relative poverty, which determine an array of environmental and biological factors that in turn increase rates of mortality, morbidity and generally poor health. 

It was shown in a 1958 study of British Males that birth weight corresponds to Housing inadequacy and financial difficulties. Indeed biology seems to determine SEP as well as SEP determining biology. A child’s height at the age of 7 has been shown to directly correlate to their chances of unemployment. 


So how does the NHS effect this matrix of determinant factors?


One can deduce two levels at which a national health system attempts to ameliorate the situations of a population’s lower classes. 

The first level is that of education, which is essentially a preventative measure. In reality this involves working against the default positioning of individuals facing an adverse SEP. With more quotidian and fundamental priorities education becomes seemingly remote from their day to day needs. However, a health system will try and educate on matters such as nutrition and lifestyle. It has to be said that the NHS has played a significant role in making smoking socially unacceptable and advocating legislation preventing smoking in public places. So within preventative measures there is legislation about education, literally barring unhealthy habits and there is also the dissemination of information, which aims at raising awareness of key issues. 


The second level at which a health system will try to improve the health of individuals facing adverse socio-economic positioning is the tailoring of the system to accommodate for the tendencies of those effected by their social class. Types of interaction from professionals working in the system will be designed in order to welcome individuals and encourage them to seek medical help. For instance - SEP is shown to correspond to the chances of domestic violence, also linked to alcohol and drug abuse, which is tied into SEP – work done to encourage women to seek help in the community when they are subjected to violence from their husband or partners. 




There are, however, ways in which health systems undermine themselves and accentuate class divisions in the operative places of health provision. 

Private prescribing in the NHS, a recent development and a product of the Health and Social Care Act (2012) not only creates a materially two tiered health system. It also re-enforces class in the hospital. By having medicines withheld for less well off patients they are implicitly but unmistakenly told that you are as good as your money. Further, the deeply entrenched class divisions of English Society are not simply about money. Class consciousness can manifest itself through deep insecurities about moral fibre and character. This undoubtedly has bearings on one’s health as stress and anxiety takes a physical toll. 

Many regard the notions of tough, well-versed middle class patients dominating the health system and rendering it two tiered as a myth. 

I do not think that they are a mythical people, and indeed represent the class divisions I am speaking of. 

Yet the problem is not localised incidents of class consciousness, where staff are more respondent to middle class patients, the real problem is more far reaching and generalised. There is a dramatic inequity between NHS services in the inner city and the countryside or suburb (click here). This highlights a typical capitalist contradiction where the stated aims of a State Service are subverted by powerful class interest ultimately working to undo the State of which they (class interest) are the deepest stakeholders.

21 comments:

  1. Who is Max Faulkner? What does he have to do with MS? Between him and Dr Dre this blog has become a socialist’s playground. Americans readers must be getting irked by their constant pleas for communist utopia. Those us working hard for all we’ve achieved in life actually deserve what we can access with our money. If you can’t afford good things then you should have worked harder in school.

    Equal health care is ruining my opportunity to be cured of MS. That’s not fair. Surely you can empathise?

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    1. Even though the majority of our visitors are from the USA, this blog is based in the UK and so we post on issues that are primarily of interest to UK MSers. That many others around the world also find it useful is great.
      In the UK, the creation of the NHS (by a socialist government) is a source of great pride to the vast majority of those in the UK. Any attempts to undermine it will be fought tooth and nail. It isn't perfect but its sure better than the alternatives.
      You say that those who can't afford good things should have worked harder in school, well I have to tell you that it isn't quite a black and white as you suggest.
      To suggest that those who can afford to pay should get the best treatment and the devil take the hindmost strikes me as the politics of despair.

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    2. You tell 'em, MD2! Some of the self-centred comments posts like this get almost scare me at times and really makes me feel I'm on my own when it comes to common welfare. The American readership of this is huge primarily because they are the biggest English speaking country in the world and have a lot of MSers because of population numbers.

      One can never be too socialist when it comes to our health and free access to treatments.

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    3. RIght on, anon 7:14. If you're poor, just stop being poor. That's the American perspective.
      http://www.thedailyshow.com/watch/thu-march-6-2014/third-world-health-care---knoxville--tennessee-edition?xrs=share_copy

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    4. Wonderful reply!! God, I love this blog.

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  2. We need to worry about the state of things. This won't end well, it seems. Britain is morally bankrupt, maybe even financially too.

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  3. Is healthcare a basic human right? If not then then this post is irrelevant to MS. If it is then this post is highly relevant to MS. Why should the care you receive under the NHS depend on where you live, what you earn and your position in society? Surely we should be compassionate and want all MSers to be treated the same? This is not about capitalism, socialism or communism it is about health and access to health.

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    1. Should our estimation of what is a 'basic' human right be static? Surely with technological progress 'basic human right' should be progressing correspondingly.
      Whats more, the most advanced and wealthiest countries should be aiming to provide beyond what we consider basic human rights.

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  4. Please just stick to what this blog is good at i.e. Research on b cells, ebv, trial results. I come here to get information about my disease and what research is finding out. Perhaps ms research has come to a halt / there's nothing to report. Stick up a picture of Donald Duck, anything but this politics / healthcare stuff.

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    1. Some find it interesting, as what happens to the NHS will have obvious implications for MSers. You obviously don't but be assured that the prime focus of the blog remains the dissemination/interpretation of MS research/clinical findings etc.

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  5. I presume your comment about the inequality in the last paragraph relates to the inabilkity of the poor and middle classes in the countryside to access the best neurological services as they are in the polstcode for local hospitals who often do not have the time or expertise to access up to date treatments whereas the poor in London quite often live in postcode areas attached to the big teaching hospitals eg Camberwell and Kings. Also your picture of the Eton boys as representative of the middle class seems very unfair- Eton boys probably don't bother accessing the NHS and have all their care privately. You'd be better showing a suburban semi with a Ford Fiesta outside

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  6. I love it when this blog has a go at the privileged classes. I used to come for the research but the politics is so much more interesting. It also provokes the best comments. It's brilliant.

    The blog is evolving in very interesting ways. Five years on it's become a force to be reckoned with in every way. Keep up the excellent work.

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    1. Come for the research, stay for the politics.

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  7. "middle class patients dominating the health system" could this be linked to the fact that the upper middle classes dominate the medical profession in the UK ? I would certainly not consider myself to be tough or well-versed but, by virtue of the way I operate in work and in my social interactions, I try to educate myself before any meeting. So when I was being diagnosed with MS, or in understanding the DMT options open to me I prepared for the questions I wanted to ask my neurologist.

    Does that approach make me sharp-elbowed or does it somehow tip the balance of fairness against another MSer who is less prepared and maybe doesn't see the neurologist as an equal ?

    My personal experience of three neurologists I encountered during the long diagnosis phase before ending up (fortuitously) with my current MS specialist was that I had to suppress my fears and uncertainties around what the hell could be wrong with me and be pretty robust to deal with some of the most arrogant individuals I have ever met - not suggesting Prof G is like this...

    I have Tysabri infusions at a large London hospital and am one of a number of patients who share their experiences / stuff they've learned / meds that have helped with various symptoms etc with any of our cohort who bring the topics up in conversation.These are people who don't tend to follow blogs like this or pro-actively seek out information and who lack confidence in raising the subject directly with the neurologist / MS nurses before getting peer advice. How do medical professionals ensure they project a friendly, approachable manner that contributes to the best two-way conversation ?

    This blog is reaching a lot of MSers but there are many, many others who wouldn't think to access a site like this or would find some of the language inpenetrable. There is a remaining challenge to reaching out further to inform and empower even more MSers.

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    1. Anon 9.40 makes some excellent points

      I'd like to add something:
      Even in the UK, where the NHS is supposed to treat everyone the same, middle-class patients end up getting better care than others.
      Imagine the plight of the less well-off or less-educated in places where the system does not even aim for equal treatment

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  8. You've probably seen this, and I'm sure it will be like a red rag. It was not written by me, but by a professor of economics apparently. It's political not directly about MS- so don't read it if you don't like that aspect of the blog- but it relates to taxes which is how we fund the NHS.

    Suppose that every day 10 men go out for a beer and the bill for all 10 comes to £100....

    If they paid their bill the way we pay our taxes, it would go something like this
    The first four men (the poorest) would pay nothing
    The fifth would pay £1
    The sixth would pay £3
    The seventh would pay £7
    The 8th would pay £12
    The 9th would pay £18
    The tenth man (the richest) would pay £59.

    So that's what they decided to do..

    The 10 men drank in the bar every day and seemed quite happy with the arrangement, until one day the owner threw them a curved ball.

    'Since you are such good customers' he said 'I'm going to reduce the cost of your daily beer by £20'.
    Drinks for the 10 men would now cost just £80.

    The group still wanted to pay the bill the way we pay our taxes.

    So the fist four men were unaffected. They would still drink for free.

    But what about the other six men? The paying customers? How could they divide the £20 windfall so that everyone would get his fair share?

    They realised that £20 divided by six is £3.33. But if they subtracted that from everybody's share, then the 5th and 6th man would end up being paid to drink their beer.

    So the bar owner suggested that it would be fair to reduce each man's bill by a higher percentage the poorer he was, to follow the principle of the tax system they had been using, and he proceeded to work out the amounts he suggested that each should now pay..

    The 5th man, like the first four, now paid nothing (100% saving)
    The sixth man now paid £2 instead of £3 (33% saving)
    The seventh man now paid £5 instead of £7 (28% saving)
    The eighth man now paid £9 instead of £12 (25% saving)
    The ninth man now paid £14 instead of £18 (22% saving)
    The tenth man now paid £49 instead of £59 (16% saving)

    Each of the 6 men was better off than before. And the first four continued to drink for free. But once outside the bar, the men began to compare their savings.

    'I only got a pound out of the £20 saving' declared the 6th man. He pointed to the 10th man ' but he got £10!'
    'Yeah, that's right,' exclaimed the fifth man,'I only saved a pound too. It's unfair that he got ten times more benefit than me!'
    "That's true!' shouted the seventh man, "Why should he get £10 back, when I only got £2? The wealthy get all the breaks!"
    "Wait a minute," yelled the first four men in unison,"we didn't get anything at all. this new tax system exploits the poor!"

    The 9 men surrounded the tenth man and beat him up.

    The next night the tenth man didn't show up for drinks, so the nine sat down and had their beers without him. But when it came time to pay the bill, they discovered something important. They didn't have enough money between all of them for even half of the bill.

    And that everyone, is how our tax system works. the people who pay the highest taxes will naturally get the most benefit from a tax reduction. Tax them too much, attack them for being wealthy, and they may not show up anymore.
    In fact, they might start drinking overseas, where the atmosphere is somewhat friendlier.



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    1. Or the 10th man hides his income offshore, has no declared income and drinks for free? ;-)

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    2. or is resident abroad and only lives here less than 42 days a year; or uses good accountants for tax avoidance/evasion; or is a multinational company like Google. These are stereotypes like those those portrayed as benefit scroungers. Most people may not like it but they pay their taxes

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    3. Sorry, MD2- so used to getting a kicking for saying anything in favour of capitalism, had a sense of humour failure!

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    4. Lexie is right. The kicking usually comes from Dre who turns everybody he doesn't agree with into a living joke. We should do the same to him too.

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